Routine inspection·May 28, 2025

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Vivencio Ignacio. LPA stated the purpose of the visit. ADM stated the facility has 4 residents. LPA observed 4 residents and 2 staff. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 37 degrees F and Freezer at -6 degrees F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 6/24/2024. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was on 12/2/2024. ADM stated the facility will conduct a drill by 5/30/2025. LPA toured 6 resident bedrooms. All 6 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. Page 1 of 2 LPA toured 2 bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range of 111.9 degrees F to 116.9 degrees F. LPA reviewed 4 resident records. Resident records included emergency contact information, physician’s report, needs and service plans, and personal rights. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA observed 2 out of 4 CSMDRs were not documented to include R2 and R4's recent prescription refills from April 2025. ADM stated understanding of Title 22 regulations for centrally stored medications. A Technical Violation was issued. LPA reviewed 4 staff records. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record, and staff training. No deficiencies were cited during today's visit per California Code of Regulations Title 22. A Technical Violation was issued, see LIC9102. An exit interview was conducted with Administrator Vivencio Ignacio and a signed copy of this report was provided.